Nebulised ipratropium and salbutamol in asthma.

Abstract

SUMMARY Treatment with nebulised salbutamol or a mixture of salbutamol and ipratropium was given to 138 children. Length of hospital stay and number of nebulised doses required did not differ. In severe asthma response was greater with salbutamol alone. In mild asthma response was greater with combined treatment.Ipratropium bromide is an effective bronchodilator in children.L3 There are potential advantages in combining it with a beta adrenergic agent in treating asthma.2 We aimed to discover whether the addition of ipratropium to treatment with salbutamol would lead to a therapeutic response greater than that attainable with salbutamol alone. PatientsAll patients admitted to our hospital because of asthma between October 1984 and March 1985 were studied. There were 138 children, 95 boys and 43 girls. Their ages ranged from 11 months to 15 years, with a mean of 5-0 years. Thirteen were aged under 18 months. One hundred and five (76%) had had one or more previous admissions for asthma. MethodsThe children were randomly allocated to a salbutamol or a combined treatment group. The former received 5 mg salbutamol and the latter 5 mg salbutamol mixed with 0-25 mg ipratropium in each nebuliser. Nebuliser solutions were of equal tonicity and were administered double blind.There were 70 patients in the salbutamol group and 68 in the combined treatment group. Standardised admission sheets were used, which incorporated a score of clinical severity (scale: 0-10). The mean admission scores in each group were almost identical (4.69 and 4.52). The age and sex distribution were similar, as were the past history, family history, parental smoking history, and drugs used before admission.Nebulisers were given within set limits at the discretion of the nursing staff. Steroids were given to children not responding satisfactorily to nebulised treatment, and intravenous aminophylline was given to children in severe respiratory_distress.In those old enough to produce accurate readings peak expiratory flow rates were measured immediately before and 20 minutes after treatment (except at night). Percentage changes in the peak expiratory flow rate were stratified so that responses were compared at similar degrees of severity. All statistics were analysed using the Wilcoxon rank sum method for unpaired data. Results

Combined Ipratropium and 2-Adrenergic Receptor Agonist in Acute Asthma

“…Interestingly, in the group with less severe airflow obstruction, patients receiving com-58 JABFP January-February 2000 Vol. 13 No.1 bination therapy had a greater increase in FEV I from baseline at 90 minutes of 522 ± 44 mL compared with 346 ± 38 mL (P < .005) for patients receiving albuterol only. In the subgroup with more severe airflow obstruction, there was no difference between groups in the change in FEV I at 90 minutes.…”

“…Issues that have not sufficiently been addressed in clinical trials are subjective parameters, such as symptom improvement 64 JABFP January-February 2000 Vol. 13 No.1 and a patient's perception of whether ipratropium is beneficial. Further trials enrolling patients with PEFRlFEV!…”

“…13 No.1 tropium," "acute asthma," and "acute severe asthrna." This search was further limited to human clinical trials published in the English language.…”

“…Another group received only one ipratropium dose (group 2), and the final group 60 JABFP January-February 2000 Vol. 13 No.1 received none (group 3). To avoid confounding factors, corticosteroids and other bronchodilators were not given during the study period.…”

Severe acute asthma in the child

“…Apesar de ser empregado para tratamento da asma há mais de uma década, ainda hoje, a sua eficácia é discutida 29 . Quando usado isoladamente a sua ação broncodilatadora é fraca, por isso recomenda-se a sua associação com os simpaticomiméti-cos a cada 4 horas na asma aguda grave ou até a cada hora em alguns casos [30][31][32] . A dose recomendada é de 125 a 250 µg/dose em crianças abaixo de quatro anos e 250 a 500µg em crianças acima de quatro anos ou 5-7 µg/kg (1 ml da solução tem 250 µg) 33 .…”